Monkey pox presentation

1. MONKEYPOX
•BY
•DRS. BARMINAS R/OKEKE
MENTOR GROUPS

2. OUTLINE
2
• Introduction
• Epidemiology
• Transmission
• Signs andSymptoms
• Differential Diagnosis
• Diagnosis
• Treatment andVaccination
• Prevention
• Prognosis
• Summary

3. INTRODUCTION
3

4. • Aetiology: MonkeypoxVirus
• Double stranded DNA
• Familiy – poxviridae, genus - Orthopoxvirus
(Members:Variola virus-Smallpox,Vaccinia virus –Smallpox vaccine,
cowpox virus)
• Has symptoms similar to those of smallpox but with less severity
• Occurs sporadically inCentral andWestAfrica’s tropical rainforest
• Monkeypox first discovered in 1958, 2 outbreaks of pox-like disease
occurred in colonies of monkeys kept for research, hence the name
‘monkeypox’
4

5. 5
Monkeypox case definitions
 Suspected case: this is an acute illness with fever > 38.3oc,
intense headache, lymphadenopathy, back pain, myalgia
and intense asthenia followed by 1-3 days with
progressively developing rash often beginning from the
face.
 Probable case: it is a case that has met the clinical case
definition, not confirmed in the laboratory but has an
epidemiological link to a confirmed case.
 Confirmed case: a clinically compatible case that is
laboratory confirmed.
 Contact: any person who has been in direct or indirect
contact with a confirmed case since onset of symptoms.

6. EPIDEMIOLOGY
6

7. • Human monkeypox – first identified in 1970 in a 9 year old boy – Democratic
republic ofCongo
• It is endemic in this region
• NATURAL HOST
• InAfrica: rope & tree squirrels,Gambian rats, Striped mice, Dormice, Primates
• InUSA: transmission fromAfricanAnimals to susceptible non-African species
(e.g. prairie dogs) with which they were co-housed
• Major outbreaks:
• 1996-1997 – DRC
• 2003 –USA (from close contact with pets infected byAfrican rodents) 47 cases
7

8. • Sporadic cases:
• 10African countries has been affected - DRC, Republic of theCongo,
Cameroon,CentralAfrican Republic, Nigeria, IvoryCoast, Liberia, Sierra
Leone,Gabon andSouthSudan.
• Nigeria – 2017 –2019: largest documented outbreak (~ 40years after last
confirmation)
• 2018-UK with 3 cases
• 2018 - Israel with 1 case
• 2019 –Singapore with 1 case
• Monkeypox virus has only been isolated twice from animals in nature:
• First – illAfrican rodent (rope squirrel) in DRC – 1958
• Second – dead infant Mangabey inTai National Park,Cote d’Ivoire -20128

9. CURRENT MULTI-COUNTRY OUTBREAK.
• SINCE 1 JANUARY AND AS OF 22 JUNE 2022, 3413 LABORATORY
CONFIRMED CASES AND ONE DEATH HAVE BEEN REPORTED TO
WHO FROM 50 COUNTRIES/TERRITORIES IN FIVE WHO REGIONS.
• THE MAJORITY OF LABORATORY CONFIRMED CASES (86%) WERE
REPORTED FROM THE WHO EUROPEAN REGION.
• OTHER REGIONS REPORTING CASES INCLUDE: REGION OF THE
AMERICAS (11%),
• THE AFRICAN REGION (2%),
• EASTERN MEDITERRANEAN REGION (<1%) AND
9

10. IN NIGERIA
• FROM JANUARY 1ST TO 19TH JUNE 2022, THERE HAVE BEEN 162
SUSPECTED CASES IN TOTAL AND 41 CONFIRMED CASES FROM SIXTEEN
(16) STATES – LAGOS (8), ADAMAWA (5), BAYELSA (4), DELTA (3), EDO (3),
RIVER (3), CROSS RIVER (2), FCT (2), KANO (2), IMO (2), PLATEAU (2),
NASARAWA (1), NIGER (1), OYO (1), ONDO (1) AND OGUN (1).
• **ALTHOUGH FMC KEFFI HAS 2 CONFIRMED CASES AS AT 4/7/22.
• ONE DEATH WAS RECORDED IN A 40-YEAR-OLD MAN WITH CO-MORBIDITY
THAT WAS RECEIVING IMMUNOSUPPRESSIVE DRUGS
10

11. 11

12. TRANSMISSION
12

13. • Natural reservoir of monkeypox is
unknown
• Most likely reservoir host –African
rodents
• InAfrica human infection has been
documented from handling of
infected monkeys,Gambian giant
rats, squirrels
• Index cases infection results from:
direct contact with bodily fluids,
cutaneous or mucosal lesions of
infected animals
Points of entry:
• Broken skin (even if invisible)
• Respiratory tract
• Mucous membrane (eyes, nose,
mouth)
Animal –to-human transmission:
• bite/scratch
• bush meat preparation
• direct contact with body
fluids/lesion material
• indirect contact with lesion material
13

14. Secondary or human-to-human
transmission:
• respiratory droplets –usually
face-to-face contact needed
• direct contact with body
fluids/lesion material
• indirect contact- contaminated
cloths, linens
• Inoculation
• Via the placenta (congenital
monkeypox)
*NO EVIDENCETOTHE
CHANCEOF PERSON-TO-
PERSONTRANSMISSION
ALONESUSTAINING
MONKEYPOX INFECTIONS IN
HUMAN POPULATION
14
• Genetic groups/Clades of the
virus:
• TheCongo Basin (more
virulent- severity,
motality,spread) orCentral
African
• TheWestAfrican

15. 15

16. Incubation period: 6-16 days
(accepted range: 5-21days)
Asymptomatic
Infection period:
The invasion period/
prodrome (0-5days)
Fever, intense headache,
lymphadenopathy(occurs with fever, 1-
2 days before rash, rarely with rash,
Affects submandibular, cervical,
axillary or inguinal LN, on both or either
sides) , back pain, myalgia, intense
asthenia, chills, unproductive cough.
The skin eruption period (1-
3days after appearance of fever)
Centrifugal in nature
Affects the Face – 95% of cases
The palms and soles – 75%
Oral mucous membranes – 70%
Genitalia – 30%
Conjunctivae/cornea – 20%
16

17. • The lesion progress through
several stages before falling
off.
• The person is contagious from
onset of enanthem through
scab stage
• Person no longer contagious
after all scabs falls off
• Pitted scars and or areas of
lighter/darker skin may remain
all scabs fall off
17

18. 18

19. • Crusts might take about 3 weeks to completely disappear
• Number of lesions varies from few to several thousands
• Usually self-limiting
• Duration of symptoms: 14-21days (2-4weeks)
• Severe cases seen more in children.This is related to:
The extent of virus exposure
Patient’s health status
Severity of complications
• ?Asymptomatic infections – people living in or near forested
areas or low-level exposure to infected animals 19

20. DIFFERENTIAL DIAGNOSIS
20
 Smallpox
 Chickenpox
 Measles
 Bacterial skin infections
 Scabies
 Syphilis
 Medication-associated allergies

21. DIAGNOSIS
21

22. 22
symptoms monkeypox chickenpox measles
Fever Fever >38 Oc
Rash After 1 To
3d
Fever To 39 Oc
Rash After 0 To
2d
High Fever To
40.5oc
Rash After 2 To
4d
Rash Appearance Macules,
Papules,
Vesicles,
Pustules Present
At The Same
Stage On Any
Area
Macules,
Papules, Vesicles
Present In
Several Stages
Non-vesicular
Rash In Different
Stages
Rash
Development
Slow; 3 To 4wks Rapid, Appear In
Crops Over
Several Days
Rapid; 5 To 7d
Rash Distribution Starts On Head;
More Dense On
Face And Limbs;
Appears On
Palms And Soles
Starts On Head;
More Dense On
Body; Absent On
Palms And Soles
Starts On Head
And Spreads;
May Reach Heads
And Feet
Classic Feature Lymphadenopath Itchy Rash Koplik Spots

23. THE FOLLOWINGTYPES OF SPECIMENS SHOULD BE COLLECTED IN ACCORDANCE
WITH STAGE OF DISEASE
23
Disease Phase Specimens toCollect
Prodrome Tonsillar tissue swab
Nasopharyngeal swab
Acute serum and whole blood
Rash*
Macules or Papules Tonsillar tissue swab
Lesion biopsy
Acute serum and whole blood
Vesicles or Pustules Lesion fluid, roof, or biopsy
Electron microscopy grid (if supplies available)
Acute serum and whole blood
Scabs orCrusts Lesion scab or crust
Acute serum and whole blood
Post-Rash Convalescent serum

24. • Definitive diagnosis – Laboratory
* More than one lesion should be
sampled, preferably from different
locations on the body and/or from
different looking lesions.
• Optimal diagnostic specimen are
from lesions:
Vesicular swabs of lesion
exudate/crust
• Store in dry, sterile tube
• Keep cold
Blood/serum – often inconclusive
• Short duration of viremia
• Timing of specimen collection
Information needed for result
interpretation:
• Approximate date of onset of fever
• Date of onset of rash
• Date of specimen collection
• Current status of the individual
(stage of rash)
• Age
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25. TREATMENT AND VACCINATION
25

26. • No specific treatments/ vaccines
• Outbreaks can be controlled
• Vaccination against smallpox = 85% effective prevention of
monkeypox
*vaccine no longer available since discontinued following global
smallpox eradication
• Prior smallpox vaccination will likely result in milder disease course.
• Antivirals [Cidofovir,Brincidofovir (CMX001),Tecovirimat (ST-246)]
and vaccinia immune globulin (VIG) can also be used, but no data
supports this.
26

27. PREVENTION
27

28. A. Reducing the risk of infection in people
In outbreaks, most significant risk factor is close contact.
• Raise awareness of the risk factors
• Education on measures to reduce exposure to the virus
• Surveillance measures
• Rapid identification of new cases
Public health educational messages should focus on the following risks:
Reduce risk of animal-to-human transmission
• Avoid contact with rodents and primates
• Limit direct exposure to blood and meat
• Thorough cooking of meat prior to consumption
• Personal protective equipment should be worn while handling sick animals, infected
tissues and in slaughtering procedures 28

29. B. Reduce risk of human-to-human transmission
• Avoid close contact with infected person/contaminated
materials
• PPE worn while caring for ill persons
• Regular hand washing after caring or visiting infected person
• Isolation of patients – either at home or health facilities
*Following discontinuation of isolation precaution, affected
individuals should avoid close contact with
immunocompromised persons like:
• - Immunologic disorders: HIV infection, congenital immune
deficiency syndrome
• -Chronic dx e.g. Dm,Ca, Emphysema,CF
• - Immunosuppressive therapy e.g. radiation,Cytotoxic chemo,
anti-rejection
29

30. C.Controlling infection in health-care settings
• Standard infection control precautions among health workers in caring for
suspects and confirmed case and their specimens
• Immunization of health workers against smallpox
*Older smallpox vaccines should not be administered to immune-
compromised people.
• Suspected samples should be handled by trained staff working in suitably
equipped laboratories
•In transporting samples, ensure safe packaging
and follow infectious substances guidelines.
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31. Clinicians
• High index of suspicion when symptoms are present
• SpecimenCollection
• Effective communication and precautions between specimen
collection teams and laboratory staff is essential
• Clear labelling systems for all infected samples
• Proper sample collection techniques
31

32. • Laboratory personnel
• Laboratory exposures to poxviruses occurs primarily through:
• Needle pricks
• Direct contact with specimen
• Aerosols generated by lab procedures
• Limit number of staff testing specimens
• PPE
• Rigorously applied standard precautions
• Avoid any procedures that could generate infectious aerosols 32

33. Veterinarians
• Consider all mammals as susceptible to monkeypox
• Beware of animal-to-animal transmission
• Ensure good hand hygiene, waste disposal, environmental
sanitation, laundry
• In treating suspected animals use PPE, protect staff, clients and
other animals
• Preventing monkeypox expansion through restrictions on animal
trade
• Restrict/ban the movement of smallAfrican mammals and
monkeys
• Isolate/quarantine potentially infected animals
• Quarantine all contact animals, handle with standard precautions
and observe for monkeypox symptoms for 30 days.
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34. COMPLICATIONS
34
Pitted scars
Deforming scars
Secondary bacterial infection
Bronchopneumonia
Respiratory distress
Keratitis
Corneal ulceration
Blindness
Septicemia
Encephalitis

35. PROGNOSIS
35
• Mortality rates ranging from 1-10% have been reported inAfrica
• No fatalities occurred in theUnitedStates 2003 outbreak.
• Death rates are disproportionately high inAfrican children.
• Factors influencing prognosis:
Health status
Comorbidities
Vaccination status
Severity of complications
Uncomplicated cases resolve in 2-4 weeks, with only pock scars
remaining.

36. SUMMARY
36
• smallpox vaccination was highly effectiveinpreventing monkeypox as well.

37. REFERENCES
• CENTERS FOR DISEASECONTROLAND PREVENTION (28SPTEMBER, 2018) MONKEYPOX.
HTTPS://WWW.CDC.GOV/POXVIRUS/MONKEYPOX/CLINICIANS/CLINICAL-
RECOGNITION.HTML
• GRAHAM M.B. ETAL (28AUGUST, 2018) MONKEYPOX. MEDSCAPE
• HTTPS://EMEDICINE.MEDSCAPE.COM/ARTICLE/1134714-OVERVIEW#A4
• NIGERIACENTREFOR DISEASECONTROL (JANUARY 2019) NIGERIA MONKEYPOX MONTHLY
SITUATIONREPORT.
FILE:///C:/USERS/QBAS/DOWNLOADS/AN%20UPDATE%20OF%20MONKEYPOX%20OUTBR
EAK%20IN%20NIGERIA_310119_5.PDF
• WORLDHEALTHORGANISATION (6JUNE,2018) MONKEYPOX.
HTTPS://WWW.WHO.INT/NEWS-
• ROOM/FACT-SHEETS/DETAIL/MONKEYPOX
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